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General NPI Number Information
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NPI Number | 1497788608
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Entity Type | Organization
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Legal Business Name | RANDALL HILE MD PC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 1020 E COMMERCIAL AVE
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City | LOWELL
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State | IN
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Zip | 46356-2310
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Country | US
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Telephone | 219-696-3052
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Fax | 219-696-4629
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Provider Business Mailing Address
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Address Line | 6105 W 177TH AVE
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City | LOWELL
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State | IN
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Zip | 46356-1971
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Country | US
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Telephone | 219-696-0779
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Fax | 219-696-4629
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RANDALL LEE HILE
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Credential | M.D.
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Telephone | 219-696-0779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01030234A
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License Number State | IN
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